The Voice of Podiatrists

Serving Over 12,000 Podiatrists Daily

March 23, 2010 #3,812 Publisher-Barry Block, DPM, JD

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New Dress Shoe Can Accomodate Orthotics: CA Podiatrist

Although companies such as Cole Haan and Kenneth Cole have comfort lines, Dana Davis' is the first to feature built-in orthotics (developed with patent-pending technology) in a high-fashion shoe, particularly heels. Her styles, priced at about $275 to $450, are designed so that you can also easily put in your own orthotic if needed. "Previously, there was no dress shoe you could put an orthotic into, so this is a big step," says podiatric surgeon Dr. Robert K. Lee, who says his patients like to wear high-fashion shoes but can develop foot problems as a result.

Dr. Robert K. Lee

"Current styles tend to be far too narrow, which can lead to bunions, hammertoes or other foot conditions. As the heel gets higher, that's more load on the balls of your feet, which can lead to stress fractures or tendinitis." He notes that the distribution of weight is key to preventing injury. Davis' shoes create a tripod between the first and fifth metatarsals — the long bones of the foot — and the heel to displace weight. Her heels feature platforms and cushions, whereas most lines have a single sole. There is not a single skinny stiletto heel in the group.

Source: Victoria Namkung, Los Angeles Times {3/21/10]

AZ Podiatrist Installed as APMA President

Dr. Kathleen Stone was installed today as the president of the American Podiatric Medical Association. She is the first woman to hold this position. In her acceptance speech, Stone said, “We must remain true to Vision 2015 and beyond to ensure our parity, respect and solid placement as a valued and integral part of the healthcare team.” 

(L-R) Dr. Kathleen Stone, Colleen Stone Daley, and  Dr. H.F. "Bunny" Brown, III.

Earlier today, Michael Goodwin, president of the OPEIU, a component of the AFL-CIO, was presented the APMA President’s Award for his efforts on behalf of the profession.

TN Podiatrist Appointed to Podiatry Board

Dr. Lawrence Burns

Dr. Lawrence Burns has been  appointed to the Podiatric Medicine Board of Registration by Gov. Phil Bredesen. Burns serves as a podiatrist on the staff of Saint Thomas Hospital in Nashville.

Query: Golf Shoe Fitting
 
Where does one go for professional fitting of golf shoes? I have several high-end athletic shoe stores to send my patients to for all other forms of athletic footgear. The local sporting goods stores (Dick's, etc.) are not good resources for golf shoes. Are there particular brands and/or models of shoes that can be recommended? Any resources for proper fitting?  
 
Greg Caringi, DPM, Lansdale, PA

RE: Plantar Plate Tear (Brent Rubin, DPM)
From: Multiple Respondents

Plantar plate tears are most often caused (in the absence of acute injury) by attrition of the plate due to propulsive phase metatarsalgia (an elongated metatarsal "pole vaulting" over the plantar plate for many years).

Once the plate has a partial or complete tear, conservative measures include the use of a Budin-type splint or "toe prop" type pad that has been around for years. The condition often, but not always, is accompanied by a hammertoe deformity. Orthoses with a metatarsal pad are also helpful but things tend to get bulky for shoe wear.

One new device on the market that has promise for non-operative care in those patients who may be better served by non-op care is the new "Bioskin aftr brace" (just released at AAOS) with the Weil osteotomy strap that was designed to reduce the complication of a floating toe following the Weil osteotomy.

We have used this strap successfully, post-operatively following a repair of the plate and also non-operatively for the selected patient. The strap acts as a night splint and holds the toe in plantar-flexion, and can also be used as an exercise device when placed dorsally. Of course, surgical options are available as described by Lowell Weil, Jr. and Jeff Christensen, utilizing a Weil osteotomy with a plantar plate repair performed through the same incision. A partial metatarsal head resection is always an option as is the flexor transfer procedure.

Disclosure: I am the father of the designer of the Weil Strap used by Bioskin.

Lowell Scott Weil, Sr., DPM, Des Plaines, IL, weil4feet@aol.com

It sounds as though a very appropriate conservative care regimen has been employed while pursuing diagnostic studies to confirm the diagnosis. Just a couple more conservative options to consider would be the addition of a "toe-down" splint or Budin splint, the use of a carbon fiber insert beneath padded shoe inserts, and possibly the addition of an external metatarsal bar upon the sole of a sturdy shoe...all efforts to reduce forefoot pressure and diminish motion at the 2nd MPJ.  
 
Christopher L. Hendrix, DPM, Memphis, TN, hendrix333@msn.com

This is one of those cases where I feel there is a tremendous difference between suing an OTC orthotic and a custom made device. Most prefabs orthotics are "arch supports". In this particular case a custom made device can have a met pad and a dispersion around the second MPJ. A nice deep dispersion being the key.

In a similar vein, "a poor man's version" would be using either a felt "U" pad or a reusable Dr. Jills "purple pad" under the second MPJ. A third option would be an MBT type shoe or the cheaper (in price) copy Sketcher "shape ups"  with a rocker-type bottom which keeps the forefoot pressure minimized.
 
Jeffrey Kass, DPM, Forest Hills, NY, Jeffckass@aol.com

RE: Scanning vs. Casting for Orthoses (Paul R. Scherer, DPM)
From: Elliot Udell, DPM

Kudos to Dr. Scherer for starting a discussion about scanning versus plaster casting in the fabrication of  custom foot orthoses. The need for this discussion is long overdue. What is making this discussion even more timely is that Dr. Scholls is now running television commercials touting foot scanning done in stores. These appear impressive to the non-trained eye. Its purpose is to guide a patient toward the purchase of an over-the-counter product made by that company. Will patients feel that by standing on that particular scanner, they are getting the "real deal?"
 
At podiatry conventions, many labs display different scanners. As Dr. Scherer points out, if a doctor invests in such a device, he or she is locked into the use of the lab that sells that particular scanner. Another point that he makes is that the scanners available are not all alike. They all appear high-tech and will impress patients, but some of these modalities do not capture all of the biomechanical relationships that we need in order to design and fabricate a quality functional device.
 
It will serve all of us well if doctors who converted to the use of scanning could tell us if the outcome of the final product is better, worse, or equal to orthotics fabricated with the use of plaster. Identifying the particular scanner purchased would also help.
 
Elliot Udell, DPM, Hicksville, NY, Elliotu@aol.com

RE: Shelf Life of Phenol  (Amy Wahl, DPM)
From: Shari M Lee, PMAC, David S. Chung, DPM

In our office, we get our phenol from the local pharmacy in the amount of 30 ml. Our pharmacist does put the expiration date on our bottle. Example: purchased 06/03/09 shows expiration date of 07/31/2011. So, by purchasing this amount at a time, we don't have to worry about expiration as when we get over half way through the bottle, we call and they deliver another. We never have to worry about expiration. Just food for thought.

Shari M Lee, PMAC, Columbia, SC, midlandspodiatry@bellsouth.net

A few years ago, I heard one of Podiatry Institute affiliated speakers presenting his research findings on 89% phenol. According to his research, the concentration of phenol did not diminish with time. Rather, it slightly increased with time.

I have been using the same bottle of phenol for over 15-20 years and the high success rate of my P&A procedures has not changed over the years.

David S. Chung, DPM, Aloha, OR, icfeet57@yahoo.com

RE: Medicare Payment - Subtalar Arthroereisis (Lowell Scott Weil, Sr., DPM)
From: Michael J King, DPM

I would like to further elaborate on this issue of having no code for the subtalar arthroereisis. Dr. Smith very succinctly described the process, history and difficulties in obtaining such as code. As an aside, it was Dr. Jerry Maxwell who testified along with Dr. LaPorta in our pursuit of an arthroereisis code.

APMA has not dismissed this idea, quite the contrary. The Coding committee continually...

Editor's comment: Dr. King's extended-length letter can be read here.

RE: Maryland Podiatrist Opens a New Shoe Store (Robert Bijak, DPM)
From: Multiple Respondents

I find the comments regarding podiatrists and shoes to be interesting and somewhat amusing from my personal historical aspect. My father and brother, Marshall Harvey, DPM and Dabney Harvey, DPM, respectively, owned shoe stores in Lubbock, Texas in the 1940’s, '50’s, '60’s, and '70’s. One store was The Miller Shoe Store named after a popular “orthopedic” women’s shoe of the time. The other was a children’s shoe store which carried Child Life and Stride Rite shoes. There is no telling how many tens of thousands of people they helped as podiatrists who directed their foot-sore patients to the proper shoe gear. I recall others such as Jimmy Meade, DPM of Amarillo and Don Tobin, DPM of San Antonio who did the same. These men were presidents of the Texas Podiatric Medical Association and one was president of ACFS. Podiatrists owning shoe stores are nothing new. Have you noted the products that dermatologists promote in their offices? Have you noted the “readers” sold by the ophthalmologists? Have you noted the number of orthopedists who own their own physical therapy clinics?

I feel comfortable that these enterprising physicians offer the best and safest products available on the market to improve the quality of life for their respective patients. Isn’t that what it’s all about?

Pete Harvey, DPM, Wichita Falls, TX, pmh@wffeet.com

As the first owner of a Foot Solutions in Atlanta, GA (and country) and owner of various other shoe ventures, I think if you have the skill, resources, and management talent, then you can make it successful. There are podiatrists who have opened and failed in the shoe business, and I will admit that I am one of them. Managing a retail operation is very difficult and on the surface, it makes a lot of sense, but it takes a very talented individual to pull off a successful venture. In fact, my first shoe store in Buckhead, had orthopedic surgeon and podiatry investors, and it barely broke even. It was actually under the Foot Solutions franchise model. It was more stress than it was worth and the profit margins were not what we anticipated.

Again, I don't think owning a shoe store will have any negative impact on your professional life, but it will definitely add years to your personal life, if you are not well equipped to take on this venture. I would urge all of you to read the book: "Good to Great", by Jim Collins and focus on Chapter 5: "The Hedgehog Concept". I think to often we as physicians defocus too much and get distracted by things outside our core competency and unique ability. Before you think of starting a retail shoe store, e-mail me and I hope I can convince you to do something else with your money and time that will bring much higher returns on your efforts.
 
David Helfman, DPM, Atlanta, GA, dhelf18809@aol.com

There has been criticism against a podiatrist who opened a shoe store. That is centered on the “blatantly un-medical and unprofessional aspects of raw commerce.” I admit I used to feel that way. I was wrong.
 
A similar path of criticism suggests that a podiatrist who becomes a registered pedorthist is “stepping down” and that the MD’s are “laughing again.” I tire of trying to remain identified in the medical hierarchy of perfection and status. To quote Popeye the sailor man, “I am what I am.” A podiatrist/pedorthist knows more than I do. I think that’s good.
 
As a member of Kaiser Permanente in CA, I am reminded that “blatant commerce” is welcomed there with open arms. A small trip through their dermatology, optical store, and various departments will prove that in a second. They love to sell stuff, as much as they can. I buy their products because they are offered at good prices and it is very convenient. If you offer such commodities, your patients will buy them. You produce money by selling “merchandise” as well as services; and you will not be “audited” for this. Just make sure you pay sales’ taxes. 
 
Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

RE: Let's Not Go There (Jon Purdy, DPM)
From: Michael M. Rosenblatt, DPM

In regard to Dr. John Purdy's experience with a patient who had dry skin cracked hands, of course podiatrists are not allowed by law to treat the hands in most states (with Ohio being a previous exception). Dr. Purdy simply stated that the patient could use the emollient cream "wherever" she wanted. The patient replied that she is "way past that now." After a moment's bilateral blush and both deciding to just "not say anything else," I'm suggesting that podiatrists who offer creams, anti-fungal agents and other OTC products in their offices re-consider selling vibrators.

Michael M. Rosenblatt, DPM, San Jose, CA, Rosey1@prodigy.net

ASSOCIATE POSITION – LONG ISLAND 
 
Busy Bellmore, NY office. Motivated, board certified, hard-working, experienced in all phases of podiatry. F/T, P/T hours available. excellent salary, call 516 242-7540 or Fax Resume 516 826-9036 or email jobke@aol.com

ASSOCIATE POSITION – CALIFORNIA

Looking for a motivated Podiatrist to join a rapidly growing practice in Los Angeles. Excellent compensation. Please reply to coasttocoastpodiatry@yahoo.com

ASSOCIATE POSITION - SAN FRANCISCO, CALIFORNIA

We’re seeking an energetic and enthusiastic Associate to help our thriving non-surgical practice grow. We provide state-of-the-art sports medicine, trauma and lower extremity care. Excellent compensation package. Visit our website to apply.

ASSOCIATE POSITION - NORTHERN VIRGINIA/DC SUBURB

Excellent associate practice opportunity leading to partnership for PSR 24-36 foot and ankle surgically-trained physician. Currently 4-doctor/2 office practice in fast-growing area, expanding to 5 doctors. Hard working, personable, highly-motivated individuals needed. Great opportunity with excellent salary and benefits. No nursing homes. Top hospitals. Fax CV with references to 703-491-9994

PRACTICE FOR SALE - FLORIDA CENTRAL/SOUTH

Turn-key operation grossing $570,000 annually based on one full-time doctor. Great opportunity for growing the top-line. Surgery is only 14% of the professional man-hours; it can significantly increase income. Medicare makes up 64% of revenues. Seller will assist with transition. Call 863-688-1725, ask for Chas.

ASSOCIATE POSITION-BERKELEY, CALIFORNIA

We are seeking an energetic individual to join our multi-office practice in Northern California. PSR 24+ with a California license is required. Partnership position is possible with an excellent long term business opportunity for an enthusiastic and motivated individual. Please send resume to Mwolpafootdoc@yahoo.com

TWO YEAR FELLOWSHIP IN RECONSTRUCTIVE FOOT SURGERY AND RESEARCH

2-year fellowship at Beth Israel Deaconess Medical Center, a primary teaching hospital for Harvard Medical School. Fellows have clinic, perform complex reconstructive procedures (external fixation, flaps, Charcot reconstruction), and conduct clinical research (20%). Fellows train residents and receive appointment to Harvard Medical School faculty. Excellent salary/benefits. Program begins SEPTEMBER 1st, 2010. Must have completed PSR-36 or similar. Submit applications to: Dafny Suazo at dsuazo@bidmc.harvard.edu Include CV, letter describing goals and any research interests. Deadline: April 30, 2010. Beth Israel Deaconess Medical Center and Harvard Medical School are Equal Opportunity Employers.

FULL-TIME PODIATRY OPPORTUNITY - BOSTON, MA

HealthDrive is seeking a caring podiatrist to join our group practice. We currently have a FT non-surgical opportunity available in the Boston, MA area. We offer a competitive salary, Paid malpractice Insurance, health and dental Insurance, long & short term disability, flexible schedule (No weekends), established patient base, equipment, supplies and complete office support provided. If interested in this opportunity, please call Maria Kelleher (toll free) at 877-724-4410 or email caring@healthdrive.com 

ASSOCIATE POSITION - FLORIDA

Associate needed for a dynamic practice in the West Palm Beach, Florida area. Preference given to a PSR 24+ training and must have a Florida license. Well-established practice, specializing in sports medicine, surgery and trauma. Excellent hospital privileges available. Excellent salary and benefits for the right candidate. Contact/Send resume to springwm41@aol.com

ASSOCIATE POSITION-INLAND EMPIRE, SOUTHERN CALIFORNIA

Associate needed full or part-time for multi office practice. Must be ABPS BC/BQ. Hard working, ethical individual who is looking to a possible partnership opportunity. Looking for current licensed or resident completing program this spring. Email CV to bkatzman2@earthlink.net or call Martha 909 984-5614.

PM News Classified Ads Reach over 12,000 DPM's and Students

Whether you have used equipment to sell or our offering an associate position, PM News classified ads are the fastest, most-effective way of reaching over 12,000 DPM's. Write to bblock@podiatrym.com or call (718) 897-9700 for details. THIS OFFER DOES NOT APPLY TO BUSINESSES PROVIDING PRODUCTS OR SERVICES. Note: For commercial or display ads contact David Kagan at (800) 284-5451

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